vancomycin — CareFirst (Caremark)
oral vancomycin for treatment of C. difficile associated diarrhea
Initial criteria
- Requested drug will NOT be used intranasally or in a footbath
- Requested drug is being prescribed for an FDA-approved indication or an indication supported in the compendia of current literature (AHFS, Micromedex, current accepted guidelines)
- Infection is proven or strongly suspected to be caused by susceptible microorganisms
- Patient cannot be treated with oral therapy OR request is for oral vancomycin for the treatment of C. difficile associated diarrhea or staphylococcal enterocolitis
Approval duration
serious, chronic, recurring infection: 12 months; other indications: 3 months